As political theater, the spectacle of health care providers joining President Obama in a pledge to constrain medical costs sure beats a rerun of Harry and Louise. And it may well avert an encore performance, which would be a good thing. The anti-Clintoncare commercials were created by providers as a show of their frustration at being shut out of the process.
Including them this time is a lesson learned that will yield important positive atmospherics. My enthusiasm is muted by the feeling that is yet another event in the "save by spending more" competition that's been diverting us from the real issues for years. It may not be as phony as promises of a free lunch; it seems to offer an amazingly cheap one.
In fact, we've seen this show before. Somehow the long-term savings never quite meet the promises made in justifying the short-term spending, or investment as proponents tend to call it (as in "invest in educating kids today and you'll have fewer felons you'll have to house in expensive prisons tomorrow.")
While the numbers for health spending are bigger, this isn't unlike the consumer who buys a Prius to combat $4-a-gallon gas prices, but finds he never saves what he anticipated because gas has dropped to $2-a-gallon and registration fees have been hiked to make up the gas tax revenues lost.
Within the health community, this game has now been running for decades and has gotten fairly slick. Insurers and consumers argue that providing insurance for all would save money because it would eliminate the cost of uncompensated care that all of us must share, but it lowers total costs by treating people early before their problems became serious and expensive.
Drug firms argue that expensive hospitalizations could be avoided if more people took pills that cost less. Doctors claims that regular physician visits could avert emergency room care that costs a lot more. And, of course, some employers think that on-site gyms will result in fitter employees who are healthier.
All of these are good ideas that are true some of the time. All of them have been tried. And none of them have proven to be the silver bullet that reversed the relentless growth of our national health bill.
Americans are consuming more drugs and spending fewer days in the hospital and while there's a theoretical argument that the bill would be even bigger had that not happened, the reality is that the pattern of growth hasn't been reversed -- or even slowed significantly.
The White House session is an effort to paper over the reality that some of the players are going to take a hit in a reorganized system. Ideally, everyone -- which is to say both patients and providers -- would get a bit less.
But it isn't likely that such a plan of shared sacrifice will elicit a chorus of kumbuyahs that this week's White House pep rally did.
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